HomeMy WebLinkAboutMOD Application 7-2-21BAKERSFIELD FIRE DEPARTMENT
Prevention Services
UNDERGROUND STORAGE TANK
2101 H Street
PERMIT APPLICATIONP�Bakersfield, CA 93301
TO CONSTRUCT -INSTALL NEW TANK (NEW FACILITY)/NEW Phone: 661-326-3979 •Fax: 661-852-2171
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
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Permit #
TYPE OF APPLICATION: F-INEW TANK INSTALL/NEW FACILITY O NEW TANK INSTALL/EXISTING FACILITY
r "Lif-L= nKic nK11 VN n MnnT9=TrOTTnN1 nP PArTI TTY n MTNnp mnnTFTC'ATTnN OF FAC'TLITY
STARTING DATE/
PROPOSED COMPLETION DATE
FACILITY NAME Olive Refresh
EXISTING FACILITY PERMIT #
FACILITY ADDRESS 11206 Olive Dr
CITY Bakersfield
ZIP CODE 93312
TYPE OF BUSINESS gasoline facility
APN #
TANK OWNER Nirmar Gill
PHONE #
ADDRESS
CITY
ZIP CODE
CONTRACTOR BSSR, Inc.
CA LICENSE #
ICC # 5257282
ADDRESS 6630 Rosedale Hwy. #B
CITY Bakersfield
ZIP CODE 93308
PHONE #588-2777
5Q8_2777
B ER '� ELD CITY BUSINESS LICENSE #
WORKMANS COMP # C6861 286A
INSURER Ace American
BRIEFLY DESCRIBE THE WORK TO BE DONE:
repair or replacement of (87) spill bucket, check that all brine reservoirs are higher then sump penetrations and verify they
are communicating properly. Repair or replace (91) probe. check for installation of 420 sensor and riser in (87) tank and
also the diesel/prem split tank as well.
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER SOIL TYPE EXPECTED AT SITE
# OF TANKS TO BE INSTALLED
ARE THEY FOR MOTOR FUEL?
YES [71NO
SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
YES Q NO
PHIS SECTION IS FOR STORAGE TANK IDENTIFICATIO14
TANK #
VOLUME
UNLEADED
REGULAR PREMIUM j DIESEL 10THER
1
x
2
X
3
X
Tank Testing Company
NAME OF TESTING COMPANY BSSR, InC■
PHONE NUMBER 588-2777 QQ_2777
MAILING ADDRESS
NAME OF TESTER Fidel Carrillo
ICC# 5257282
THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS
PERMIT AND ANY OTHER STATE, LOCAL, AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER
PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT.
NAME OF TESTER
Fidel Carrillo
ICC#
5257282
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED 1f APPROVED BY
4 1 -1 A 4 r